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HomeMy WebLinkAbout06-02-15 (3) t)!lr pennsyivania 1505618403 TiT oevanrnre ."'EX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 15 0264 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01 28 2015 01 30 1940 Decedent's Last Name Suffix Decedent's First Name MI HESKETH ALICE M (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW RX 1. Original Return 2. Supplemental Return 3. Remainder Return(date of death prior to 12-13-82) 4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) ❑X 7. Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) 10. Litigation Proceeds Received 11. Non-Probate Transferee Return 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) 13. Business Assets 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT.THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D BOGAR (717) 737 8761 First Line of Address ONE WEST MAIN STREET Second Line of Address ,v City or Post Office State ZIP Code n 70 SHIREMANSTOWN PA 17011 c a r1 rn. CD ::0c c,> cD r-1 x c) cr. ;z. Correspondent's email address: iibogar0bogarlaw.com r- —1 _ 77 t'1 N r ry REGISTER OF Wll_.S USE ONLY C 71 REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY - (ZD r- c� cry DATE FILED STAMP Side 1 (I�I'I IIII VIII 1505618403 iil61IIII �I�II�'I'I IIII IIII 1505618403 CJS/` 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: Hesketh, Alice M. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 14 -,199- 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages and Notes Receivable(Schedule D)............................4....................... 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 9,713- 28 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested......,..... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 241704 - 00 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 48,696 - 28 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 17,093-06 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)...................................................:............ 11. 17-3093- 06 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12.. 31-v603-22 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 31,603-22 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 11 - 00 16. Amount of Line 14 taxable at lineal rate x .045 311603-22 16. 1,422-14 17. Amount of Line 14 taxable at sibling rate X.12 0.aa 17. 0 - 130 18. Amount of Line 14 taxable at collateral rate X.15 0.1111 18. 11- 01) 19. TAX DUE................................................................................................................ 19. 1,422. 14 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the Per§on sponsible for fi' g the r tum is based on all information of yh h pre arer has any knowledge. yiiL Gt-� 1� MAM 5 ( • /,- SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Susan M.Hesketh DATE ADDRESS 775 Goose Neck Drive,Lititz, PA 17543 512 zi 15- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE J mes .Bog DATE ADDRESS One West Main Street,Shiremanstown,iPA 17011 Side 2 1505616411 1505618411 REV-1500 EX Page 3 File Number 21-15-0264 Decedent's Complete Address: DECEDENT'S NAME Hesketh,Alice M. STREET ADDRESS 4516 A Warrington Avenue CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,422.14 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 1,422.14 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑x ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1503 EX+(08-12) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hesketh,Alice M. 21-15-0264 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 United Capital Individual Account-Account No.614159832. 14,199.00 TOTAL(Also enter on Line 2.Recapitulation) 14,199.00 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.08-12) .a, O . w-row:,��mm w � � '•/ } , c. 3N ovDo mpa bn`m • n r+, EL-. ,i*' j n 1n' i to ,c 2 o a. n�i m }` ° � !f 4�i t• g y 1 f to i' r a tf T7 } m:r•n h =-:' p CI } �..Z W` OD g /p ! .•, C ro m o: a D n :CL o: Al.�; O i } a ai' } 4 f ri G O a rro f 'D i O o m. n¢r'bo' oRc C: 0! y wQf • <' C1 i {• FL` F }U i. O ; .at ?. SP ! N .di r 47 d Q O yc.o c r' m m`y t a;c5 to F e ¢ F C w` 3 rn. ' } q fOL 4 yp ty A O n •, a ; 0 r ro -, f y -1 {' r ( La h y K a3Froi �»m:M ' i ; an f r+r -n 1 �' o m F m _ �:y 3: i - 4 fp m c a q N _G f F p roro 'r : to c C, 2 n w} 3 ""p ? "` f » • rs .y N fj►' m,;;�.m; a yc_? n!n?T i Ti ? m _'' a' F t �` ? F :^ - 'st } p Ci P'► a,a a a =c m m '-,° ' �'p0,' k G < 4 i '{ i rb i of F yc i •, - :'c a c r^ a:J to : m c r to } G _ O p f p+ .tr ov a�w'� anmA �•; wb j Sc _ r b r m IIr tb 7 ka 7 m ; ,�ti t O. cm Zp h on'o n: 17 c ooczi u7 : y t ( F ! F m ib r F r i rte.. C7 .7mmam 5°$o ca a•-"F ; j} I f >c _ ' : .:N$;O 04�',q m' c`pIF ' N n" r 3 n . S am O: D, ;n n i r i .1C } i• ? { '• ✓•1 A 3 !p (D ro 7 CrrmiO O C i S°n' IS 'timra,j 3 c a o h M N,+,'i a f f f ?o} 0 c a n n o y n 4 C S' m `G i me--} c 3.0 3 m o o ; i }.•..._., s}r_ i f i j NI o { i0 moo ' cn ^= S`H nii F' i i F # i { } nnK c j- jf f i �N m�° o"c ,a nn mi z m' groa `�Dr 4a^�'-0 'on; f N0 Q-�i v, G0 O :m ;l F ,'G amt m Lim 5 ': _0Jn: ?b'i y m O i"4 3? -3 d x c :m D S CLI QL 4 } wo, i.. [ d tf y r o C,a d: c' m H:... _._x.-.-._ F : r Ogip w j ' , ,t CA O antra ; �A Ch m: mnoj j' _... v F to moan ; Gym a} 00 aQ�cG'; amnc,nn ca� OL lb o w t+ n zu 3 n a H o`. on: P ;'t a► w: i - f n, f f # to Cc: ji n Jam; 3 n RA 7 f W } N r N W F F Sao : om°m.o~� �° � € = n m h ; l v. n M F } f' ' f V f fJ [fin tp �^' { Vt n o L, C, N ' am:D Om. W n n: o m T t i r f .7•o N ! a ON N >F H H j m c, rDo AU So tM 12 CL C, W O tD 1p f z - w f A it O 3 •A : �"' F• H tp n ' CL lb 3�co lb mrye J tr O p, n'Ht n C # ( } f t n .._F.._Q,. , r i i O f. 4 m cx _4# n M L: W E H F f { v Di r. G'' t'O F ��, r •Fn N n ' n Cl 00 N jf ~ C, N n a ko y e Rev-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFPERSONAL PROPERTY INHERITANCE TAXAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hesketh,Alice M. 21-15-0264 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizen's Bank-Checking Account No.6100716201. Principal balance at date of death 1,293.28 $1,293.28;accrued interest$0.00 2 2008 Honda-VIN##JHMGD38478S000703. Value per appraisal. 8,000.00 3 Personal Property-sold at private sale 500.00 TOTAL(Also enter on Line 5, Recapitulation) 9,793.28 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) Ci s � , _: One Citizens Drive ROP 112 Riverside, RI 02915 March 27, 2015 James D Bogar Attorney At Law One West Main St Shiremanstown PA 17011 Estate of ALICE M HESKETH Date of Death:Jan 28, 2015 SSN: Dear Sir/Madam: In accordance with your request,the attached information sheet has been provided in the above decedent's name as of his/her date of death. Per our records,checking account ending in 6201 came over to our bank from Mellon Bank titled as stated in 2002. We are unable to determine if account on file was a roll-over from a previous account since it opened in 1992,which exceeds our 7 year retention. For all other inquiries,please call 1-877-579-2667. Sincerely, Pamela Breton Decedent Account Processing REF#: 686123 Citizens Bank Account Number 6100716201 Account Title ALICE M HESKETH Date Opened 9/10/1992 Account Type Checking Principal Balance as of DOD $1293.28 Interest from Last Posting to DOD $ ,0Q Account Balance as of DOD $1293.28 YTD Interest to DOD $ .00 ]B .IC . • 9)MO L m (6)AC RA "A Name You Can Trust" J� May Gssnocr ( cz�= exc ti„ n�;z nod law /t'• � I• �++�G ��✓7 Coll, ir/Gelve � . 1335. I'Alanheirn Pike - Lancaster, PA, 1760 d (717) 334-0711 www.go:iones.com i Q 1 Kling• 1 ' CERTIFICATE OF TITLE FOR AVEHICLE b7c�85DOc�1t71;34Z], Gall iJt#�I&D3$47$Sflt1b"�©9 ;•:� .:,`:;�©�9� �ti0)�:DA _ .: b53IIB434�Q1 HE';. ' VEHtq-ElOT?fTiFICAT101JNUMBER-.. .. � YEAR ".. .. ... ..MAKE OF VEHICLE � .I...... .�. TITLE NUMBER -' BODY TYPE .. .•.OUp. ...�-...SEAT CAP -PRIOR TITLE STATE ODOM PT10C.D.OATS ODOM.•Mmt �•�..'.. ODOM:STATUS . DATE PAT1TLEp DATE OF ISSUE' EN UNLADWEI6HT GVWR '.:. _. 1,. OCVJA .'• 1T'ft.EBAAH03 . 'ODOMETER STATUS 0.ACTUAL MILEAGE I.MILEAGE DCCEEDS THE MECHANICAL' UmTrs . .. 2.NOT.THE ACTUAL MPEAGE . r' �,"•` ti a=NtTTTHE'ACTUAL Sw-EAOEODOMETER TAMPERINGYEIURED' _ 67 EX.BWT PkN ODOMETER DISCLOSURE TiFClSTERED �4OWNER(S) - '•'-_ "''GL'k, � .. .. SeANA.ANT LICE M . HESKETH �@� hie �tMfs6rafivdrLHr7i {'" D.COLLECTIBLE VEHICLE + t I i:'✓'/n>f r� •IiT�. f OUTOF.COUNMY _ -y- � •� -�O=ORIGINALLY.Mf00.FOA NONL.S M•yf..:.,.� y,t"e NA %J� DISIWBIRION H A0AtdlLTt1HALVl3fECLE- L LOGGM VEHICLE 'MECHANICSBURG PA 17055 R=ISIWARECOrSA POUCE'TEA� S=STREET fm • T e RECOVERED"IHEFf VEHICLE V-VEHtOLi 0OMAft AOSSUED.VEN. _ W n FLOOD VEHICLE FIRST LIEN FAVOR OF; SECOND WEN FAVOR OF: X-GWAS A'TAID _ - K a soomd eenhotdet is Mated upon satitfactlon of the first Ilon. the fust hmhoider must forward this Title to Ore Bureau of Motor Vehicles with rhe rtRiT WEN RELEASE appropriate t0rm"and fee. . DATE. SECOND WEN RELEASED . AUTHOAI2ED'RF3RFSENTATIVE DATE . MAILIM ADDRESS .. • - 1331007 BY - AUTHORIZED AEPRESENTATTVE . ALICE M HESKETH 4516 WARRINGTON AVE APT A MECHANICSBURG PA - 17055 ceift as of the date of,tssue.the otllclel records of the Pemhsiftmia Depamaa:n ALLEN. D SIEHLER - �,eThersvatsf m - ------ -... - • d the sold votAcle. - Ss nAm of TrankmUt[oa TO BE COMPLETED BY PURCHASER WHEN VEHICLE IS SOLD AND THE APPLICATION FI ' TITLE-At 1' 1APPR.P IAT IECTIONI ON THE REVERSE SIDE OF THIS DOCUMENT ARE -- sUBSCAIBED AND SWORN N a oo-plmlheser other than your spouse is listed and you want the title to TO'tTEFORE ME: be Listed,as'joint Tem, WM FtighT of SurvNomMp'(On death of ase I Owner thle.goes to survMng owner.)CHECK HERE©.Otherwise,•the the MR be issued aS'tenards In Common'(On death of oche owner,Interest of deceased owner goes to htsfier Heirs orestate). simurum OF PeRsom Aomw sym m OATH . . - - 1ST WEN DATE; -♦ IF NO WEN,CHECK Q 1ST WENHOLDER . ' STREET - . CITE' .. STATE ZIP IF THIS IS AN.ELT,CHECK HERE f"'1 FlNANpA1 W - - NOTE FIN REQUIRED (_I INSrIMdON ND. 2ND WEN DATE- —op- IF NO WEN,CHECK O C" ilio upaapnee+r�r mekw wgardn to a-ft le d Two m Uro w**&mfteo V .:&aa:k0 m to Om a own ane omen saga proms ed tomE mm2ND WENHOIDER N F� STREET O SIGNATURE OF APPLICANT OR A/THOR2M SMNEli CITY STATE ZIP IF THIS IS AN ELT,CHECK HERE flNANCIAL w SIGNATURE OF'CO.APPLICANTRnLE OP AVnfORIZED SGNER NOTE:FIN REQUIRED 1NS1I1UTTONNO. Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE /► INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Hesketh,Alice M. 21-15-0264 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °�OF DECD'S EXCLUSION TAXABLE NUMBER THE DA E DE NAME RANSFER. ATTACIiTA COPY RELATIONSHIP THE DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 United Capital IRA-Account No.614159859. Susan 24,704.00 24,704.00 M. Hesketh is the named beneficiary of this account. TOTAL(Also enter on Line 7, Recapitulation) 24,704.00 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) W N Z A 3,30 anm$ab r�` a ,, xn m +- # C M r nx O m ;0 n n': N a'tt` �- ( p F LU y wno : Hca, : °�oZY a`ai not j f i Oo : @ m # * F 1n . Al i n c m �n 3'' c=�3 3 # f # p' m;p vT'? # c i c61 y F C7 y xn p^'Co, 2 m"vmi'c axcn•n:= W ` '� [¢ tin F c1 F O '• C.j� C4 3 G. w m n°rn xd� .'N+3D 4�a �Q�' F= j : 3 O ix '4t`tr' T a x jy r•x� #' Q 4x N Q O �. ivy a ? �na� H' =i # a # o F Fo ' 3 0 € �--F ti' mn �', ncA,nst :a `�'�? r ? # _ # A• ? O fu 3 `D c 3 a e tp _� �. 3�M n` p y, ! fit ynC ° • 5 # F rD # H •'ti (nq� ^c Oa a H L1 7 H m mAD H Q#x i• 3 )C' # A. 3 a nWt # G k in% Ox 7 vn n Enn: N' �, T# F ry # lS ' #r 2+ 1 m °Fm n a, ' �S �•i ' # N y ad °� c°cn,'�; n^: 3k / 3 n # n�?a Q a m m �: _r3 # # rc i -. i # .,.F F lye 3 # a p Q wt b'i o m r• o 0 P, to c o-,l� _ .# F• _� x r• x# # #x V =np ro o a ,a ez 7 i m N F• t x 1 _ i ,� = i i sc O 41 C, yn �=•xi F a = - 3 �S Ctb OVDxu;C°` :mn i fb lb N 2 ro ? j 3 S•r"ate.!z, ! '3c'Oo H aN a';,Or;ro„S. 3 ; �' = r = f F = m !�► . m Zs`F F f i CL 0 7�5-0 nm^ o o )' f # E # F Ol o�e`~^ ' 3= °c:n Wim; } ..`_v.r ..._....#._ 3 f F t+ br 0 CL eonoF O .�+,,,•Os.: j 3 rp C ' �: # ix .< f #• F.._�_ 3_ W O n O.�•:� c rryp i- to ro .C J`tj"O• 'mnTo!.J, vmi O G p e 0 xrm+ 0'3 10 Acll i'- _ x F• F Q m a3 7 Q a: H ;.o O mm . m =y to Ipao: ono a` #' _ f rn # pf y f sp E. o aj° n p O N i Vt F '` # , # A ! # x w F a w m zu % S _ ...- C ° i p Vbi ro ry ,� # t f y i--w.i .N V # to i=x i0 °,,p^. nay H' � 1 # � # i fa ; q i � � 1 f u,b�, O Q?C m V ix it F ( r ± # -•_.'i.., _ .;+_?? en a'm z. c oayn; rtcF i # f i f f !x !D O"tp � vmmr p•p-mi ' n i N ox.` u_Ci s : .._f`---..,`_ t O to = m : n m . atr on tn n m ro H` n ! i F � lo � 1 fQ N In N m S f i F o m �." SF F aCLM ON x N # # 3 # f= yiuAb � =cm n . u" fvINw # ooF F S' M`c n! ,`m u s c ':�'. >.`_ ,,F (^' th 00 f H = 3 € 3 Ax a� oo�m m - ' # •{ .... # ,v p f tv / b w 3 w m n n # F oco cmx q as ` o.,O-o•°.�, as 3 F }11J /ll'. „G� •�j RJB. {]t = 1• r 7 # #x (• f Q .d ( ! ?�O: mNm : roro�. Ni cl- - tp • �hm:� i 5 �i �• F F # i # ry n i �fiy 00 if 3 1 3. [ff Gni EF� ... x r to c REV-1511 EX+(08-13) SCHEDULE .H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hesketh,Alice M. 21-15-0264 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedules)attached 13,481.28 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attorney's Fees Bogar& Hipp Law Offices 2,150.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD RelationshiD of Claimant to Decedent 4. Probate Fees 200.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,261.28 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 17,093.06 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Hesketh,Alice M. 21-15-0264 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Gingrich Memorials-grave marker 2,355.00 2 Musselman Funeral Home and Cremation Services-funeral bill 9,306.00 3 Slate Hill Cemetery-burial lot,opening and closing of grave 1,540.00 4 The Patriot News-obituary 280.28 H-A 13,481.28 Other Administrative Costs 5 AT&T Mobility-final cell phone bill 86.28 6 John Lorah,CPA-fee for preparation of 2014 personal income tax returns 175.00 7 Old Gettysburg VI-apartment rent 750.00 8 RESERVES:-Costs to conclude administration of Estate,including prep and filing of 2015 250.00 personal income tax returns and fiduciary income tax returns H-B7 1,261.28 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) REVA513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES p INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Hesketh,Alice M. 21-15-0264 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS (include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Diane E.Greene Daughter Twenty-five 12023 Aqueduct Road SE percent of rest, Albuquerque,NM 87123 residue and remainder Lary T.Hesketh Son Twenty-five 4626 Sunshine Drive percent of rest, Sugar Land,TX 77479 residue and remainder Susan M.Hesketh Daughter Twenty-five 775 Goose Neck Drive percent of rest, Lititz, PA 17543 residue and remainder Lisa M. Hoovervorst Daughter Twenty-five 1409 South 115th Drive percent of rest, Avondale,AZ 85323 residue and remainder Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as coppopriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiducia- ries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws . (G) To make distributions to my herein named benefi- rf ciaries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes . (I) To select a mode ofpayment under any qualified retirement plan (pension plan, profit sharing plan, employee Stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever �J manner they consider advisable. THIRD: I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. FOURTH: I nominate and appoint my daughter, SUSAN M. HESKETH, Executrix of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said SUSAN M. HESKETH, I nominate and appoint my son, LARRY T. HESKETH, Executor of this, my Last Will and Testament. I direct that my Executor, and his successors, 2 shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this IZ2 day of 2004 . (SEAL) ArfCtM. HESKETH Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address